All neoplasms are classified in this chapter, whether or not functionally active. An additional code from Chapter 3 may be used to identify such functional activity associated with any neoplasm, e.g.:

catecholamine-producing malignant pheochromocytoma of adrenal:

code 194.0, additional code 255.6

basophil adenoma of pituitary with Cushing's syndrome:

code 227.3, additional code 255.0

3. Morphology [Histology]

For those wishing to identify the histological type of neoplasms, a comprehensive coded nomenclature, which comprises the morphology rubrics of the ICD-Oncology, is given after the E-code chapter.

4. Malignant neoplasms overlapping site boundaries

Categories 140-195 are for the classification of primary malignant neoplasms according to their point of origin. A malignant neoplasm that overlaps two or more subcategories within a three-digit rubric and whose point of origin cannot be determined should be classified to the subcategory .8 "Other." For example, "carcinoma involving tip and ventral surface of tongue" should be assigned to 141.8. On the other hand, "carcinoma of tip of tongue, extending to involve the ventral surface" should be coded to 141.2, as the point of origin, the tip, is known. Three subcategories (149.8, 159.8, 165.8) have been provided for malignant neoplasms that overlap the boundaries of three-digit rubrics within certain systems. Overlapping malignant neoplasms that cannot be classified as indicated above should be assigned to the appropriate subdivision of category 195 (Malignant neoplasm of other and ill-defined sites).

All neoplasms, whether functionally active or not, are classified in Chapter 2. Codes in Chapter 3 (i.e., 242.8, 246.0, 251-253, 255-259) may be used to identify such functional activity associated with any neoplasm, or by ectopic endocrine tissue.

This section includes symptoms, signs, abnormal results of laboratory or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.

Signs and symptoms that point rather definitely to a given diagnosis are assigned to some category in the preceding part of the classification. In general, categories 780-796 include the more ill-defined conditions and symptoms that point with perhaps equal suspicion to two or more diseases or to two or more systems of the body, and without the necessary study of the case to make a final diagnosis. Practically all categories in this group could be designated as "not otherwise specified," or as "unknown etiology," or as "transient." The Alphabetic Index should be consulted to determine which symptoms and signs are to be allocated here and which to more specific sections of the classification; the residual subcategories numbered .9 are provided for other relevant symptoms which cannot be allocated elsewhere in the classification.

The conditions and signs or symptoms included in categories 780-796 consist of: (a) cases for which no more specific diagnosis can be made even after all facts bearing on the case have been investigated; (b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined; (c) provisional diagnoses in a patient who failed to return for further investigation or care; (d) cases referred elsewhere for investigation or treatment before the diagnosis was made; (e) cases in which a more precise diagnosis was not available for any other reason; (f) certain symptoms which represent important problems in medical care and which it might be desired to classify in addition to a known cause.

Use E code(s) to identify the cause and intent of the injury or poisoning (E800-E999)

1.The principle of multiple coding of injuries should be followed wherever possible. Combination categories for multiple injuries are provided for use when there is insufficient detail as to the nature of the individual conditions, or for primary tabulation purposes when it is more convenient to record a single code; otherwise, the component injuries should be coded separately.

Where multiple sites of injury are specified in the titles, the word "with" indicates involvement of both sites, and the word "and" indicates involvement of either or both sites. The word "finger" includes thumb.

2.Categories for "late effect" of injuries are to be found at 905-909.

This classification is provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of ICD) are recorded as "diagnoses" or "problems." This can arise mainly in three ways:

a) When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc.

b) When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change).

c) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories 001-999.

In the latter circumstances the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations. Examples of these circumstances are a personal history of certain diseases, or a person with an artificial heart valve in situ.

SUPPLEMENTARY CLASSIFICATION OF EXTERNAL CAUSES OF INJURY AND POISONING

0

+

Note

This section is provided to permit the classification of environmental events, circumstances, and conditions as the cause of injury, poisoning, and other adverse effects. Where a code from this section is applicable, it is intended that it shall be used in addition to a code from one of the main chapters of ICD-9-CM, indicating the nature of the condition. Certain other conditions which may be stated to be due to external causes are classified in Chapters 1 to 16 of ICD-9-CM. For these, the "E" code classification should be used as an additional code for more detailed analysis.

Machinery accidents [other than those connected with transport] are classifiable to category E919, in which the fourth digit allows a broad classification of the type of machinery involved. If a more detailed classification of type of machinery is required, it is suggested that the "Classification of Industrial Accidents according to Agency," prepared by the International Labor Office, be used in addition; it is included in this publication.

Categories for "late effects" of accidents and other external causes are to be found at E929, E959, E969, E977, E989, and E999.

Definitions and examples related to transport accidents

(a) A transport accident (E800-E848) is any accident involving a device designed primarily for, or being used at the time primarily for, conveying persons or goods from one place to another.

Includes: accidents involving:

aircraft and spacecraft (E840-E845)

watercraft (E830-E838)

motor vehicle (E810-E825)

railway (E800-E807)

other road vehicles (E826-E829)

In classifying accidents which involve more than one kind of transport, the above order of precedence of transport accidents should be used.

Accidents involving agricultural and construction machines, such as tractors, cranes, and bulldozers, are regarded as transport accidents only when these vehicles are under their own power on a highway [otherwise the vehicles are regarded as machinery]. Vehicles which can travel on land or water, such as hovercraft and other amphibious vehicles, are regarded as watercraft when on the water, as motor vehicles when on the highway, and as off-road motor vehicles when on land, but off the highway.

Excludes: accidents:

in sports which involve the use of transport but where the transport vehicle itself was not involved in the accident

involving vehicles which are part of industrial equipment used entirely on industrial premises

occurring during transportation but unrelated to the hazards associated with the means of transportation [e.g., injuries received in a fight on board ship; transport vehicle involved in a cataclysm such as an earthquake]

to persons engaged in the maintenance or repair of transport equipment or vehicle not in motion, unless injured by another vehicle in motion

(b) A railway accident is a transport accident involving a railway train or other railway vehicle operated on rails, whether in motion or not.

Excludes: accidents:

in repair shops

in roundhouse or on turntable

on railway premises but not involving a train or other railway vehicle

(c) A railway train or railway vehicle is any device with or without cars coupled to it, designed for traffic on a railway.

Includes: interurban:

electric car (operated chiefly on its own right-of-way, not open to other traffic)

streetcar (operated chiefly on its own right-of-way, not open to other traffic)

railway train, any power [diesel] [electric] [steam]

funicular

monorail or two-rail

subterranean or elevated

other vehicle designed to run on a railway track

Excludes: interurban electric cars [streetcars] specified to be operating on a right-of-way that forms part of the public street or highway [definition (n)]

(d) A railway or railroad is a right-of-way designed for traffic on rails, which is used by carriages or wagons transporting passengers or freight, and by other rolling stock, and which is not open to other public vehicular traffic

(e) A motor vehicle accident is a transport accident involving a motor vehicle. It is defined as a motor vehicle traffic accident or as a motor vehicle nontraffic accident according to whether the accident occurs on a public highway or elsewhere.

Excludes: injury or damage due to cataclysm

injury or damage while a motor vehicle, not under its own power, is being loaded on, or unloaded from, another conveyance

(f) A motor vehicle traffic accident is any motor vehicle accident occurring on a public highway [i.e., originating, terminating, or involving a vehicle partially on the highway]. A motor vehicle accident is assumed to have occurred on the highway unless another place is specified, except in the case of accidents involving only off-road motor vehicles which are classified as nontraffic accidents unless the contrary is stated.

(g) A motor vehicle nontraffic accident is any motor vehicle accident which occurs entirely in any place other than a public highway.

(h) A public highway [trafficway] or street is the entire width between property lines [or other boundary lines] of every way or place, of which any part is open to the use of the public for purposes of vehicular traffic as a matter of right or custom. A roadway is that part of the public highway designed, improved, and ordinarily used, for vehicular travel.

Includes: approaches (public) to:

docks

public building

station

Excludes: driveway (private)

parking lot

ramp

roads in:

airfield

farm

industrial premises

mine

private grounds

quarry

(i) A motor vehicle is any mechanically or electrically powered device, not operated on rails, upon which any person or property may be transported or drawn upon a highway. Any object such as a trailer, coaster, sled, or wagon being towed by a motor vehicle is considered a part of the motor vehicle.

Includes: automobile [any type]

bus

construction machinery, farm and industrial machinery, steam roller, tractor, army tank, highway grader, or similar vehicle on wheels or treads, while in transport under own power

fire engine (motorized)

motorcycle

motorized bicycle [moped] or scooter

trolley bus not operating on rails

truck

van

Excludes: devices used solely to move persons or materials within the confines of a building and its premises, such as:

building elevator

coal car in mine

electric baggage or mail truck used solely within a railroad station

electric truck used solely within an industrial plant

moving overhead crane

(j) A motorcycle is a two-wheeled motor vehicle having one or two riding saddles and sometimes having a third wheel for the support of a sidecar. The sidecar is considered part of the motorcycle.

Includes: motorized:

bicycle [moped]

scooter

tricycle

(k) An off-road motor vehicle is a motor vehicle of special design, to enable it to negotiate rough or soft terrain or snow. Examples of special design are high construction, special wheels and tires, driven by treads, or support on a cushion of air.

Includes: all terrain vehicle [ATV]

army tank

hovercraft, on land or swamp

snowmobile

(l) A driver of a motor vehicle is the occupant of the motor vehicle operating it or intending to operate it. A motorcyclist is the driver of a motorcycle. Other authorized occupants of a motor vehicle are passengers.

(m) An other road vehicle is any device, except a motor vehicle, in, on, or by which any person or property may be transported on a highway.

Includes: animal carrying a person or goods

animal-drawn vehicle

animal harnessed to conveyance

bicycle [pedal cycle]

streetcar

tricycle (pedal)

Excludes: pedestrian conveyance [definition (q)]

(n) A streetcar is a device designed and used primarily for transporting persons within a municipality, running on rails, usually subject to normal traffic control signals, and operated principally on a right-of-way that forms part of the traffic way. A trailer being towed by a streetcar is considered a part of the streetcar.

Includes: interurban or intraurban electric or streetcar, when specified to be operating on a street or public highway

tram (car)

trolley (car)

(o) A pedal cycle is any road transport vehicle operated solely by pedals.

Includes: bicycle

pedal cycle

tricycle

Excludes: motorized bicycle [definition (i)]

(p) A pedal cyclist is any person riding on a pedal cycle or in a sidecar attached to such a vehicle.

(q) A pedestrian conveyance is any human powered device by which a pedestrian may move other than by walking or by which a walking person may move another pedestrian.

Includes: baby carriage

coaster wagon

heelies, wheelies

ice skates

perambulator

pushcart

pushchair

roller skates

scooter

skateboard

skis

sled

wheelchair

(r) A pedestrian is any person involved in an accident who was not at the time of the accident riding in or on a motor vehicle, railroad train, streetcar, animal-drawn or other vehicle, or on a bicycle or animal.

Includes: person:

changing tire of vehicle

in or operating a pedestrian conveyance

making adjustment to motor of vehicle

on foot

(s) A watercraft is any device for transporting passengers or goods on the water.

(t) A small boat is any watercraft propelled by paddle, oars, or small motor, with a passenger capacity of less than ten.

Includes: boat NOS

canoe

coble

dinghy

punt

raft

rowboat

rowing shell

scull

skiff

small motorboat

Excludes: barge

lifeboat (used after abandoning ship)

raft (anchored) being used as a diving platform

yacht

(u) An aircraft is any device for transporting passengers or goods in the air.

Includes: airplane [any type]

balloon

bomber

dirigible

glider (hang)

military aircraft

parachute

(v) A commercial transport aircraft is any device for collective passenger or freight transportation by air, whether run on commercial lines for profit or by government authorities, with the exception of military craft.

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